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Decreased relative risk of pneumococcal pneumonia during the last decade, a nested case-control study

机译：一项嵌套的病例对照研究表明，过去十年来降低了肺炎球菌性肺炎的相对风险

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Background Streptococcus pneumoniae (SP) is one of the most common pathogens of Community-Acquired Pneumonia (CAP), but recent reports suggest that its incidence may be declining in relation to the use of the conjugate 13-valent pneumococcal vaccine in children. We compared the result of the immunochromatographic SP urinary antigen test (SPUAT) and clinical outcomes in patients with CAP admitted in two periods of time: 2001–2002(CAP1) and 2015–2016(CAP2). Methods This was a matched nested case-control study of two prospectively recorded cohorts of patients admitted with CAP, with SPUAT and blood culture performed in all patients. CAP2 cases and CAP1 controls were matched for age?±?4?years, sex, and Pneumonia Severity Index (PSI) score?±?10 points. Odds ratios (OR) for having SPUAT positive was estimated by conditional logistic regression. A multivariate model assessed the contribution of individual variables. Results Four hundred ninety-eight patients were recruited; 307 during the CAP1 and 191 during the CAP2 periods. Comparing both periods we observed differences, in age, PSI score, and the percentage of smokers, outpatients, previously immunized with pneumococcal vaccine, and positive SPUAT. On the other hand, mortality, admission from nursing homes, pneumococcal bacteremia and hospital admission were not different. After matching, pneumonia due to SP per the SPUAT was observed in 34(23.4%) of CAP1 and in 12(8.3%) of CAP2 patients ( p ?0.001), and 6/145 CAP1 vs 33/145 CAP2 patients had received pneumococcal immunization before their admission ( p ?0.001). A multivariate analysis confirmed that, independent of falling into PSI class 5, having not received the pneumococcal vaccine and having not survived the episode of pneumonia, there were two factors that increased the probability of having SPUAT positive: developing pneumonia during the CAP1 period (OR?=?1.23) and having pneumococcal bacteremia (OR?=?2.66). Conclusion We observed a reduction of the role of SP as pathogen, along with an increase in the number of patients who received pneumococcal immunization before admission, in 2015-2016 compared to 2001-2002. In addition, the use of conjugate 13-valent vaccine, starting in 2012 for childhood immunization, could be an additional factor contributing to these changes, as a result of early herd immunity in adults pneumonia.
机译：背景肺炎链球菌（SP）是社区获得性肺炎（CAP）最常见的病原体之一，但最近的报道表明，与儿童中使用缀合的13价肺炎球菌疫苗有关，其发生率可能正在下降。我们比较了免疫色谱SP尿抗原测试（SPUAT）的结果和在两个时间段内入院的CAP患者的临床结局：2001–2002（CAP1）和2015–2016（CAP2）。方法这是一项配对的病例对照研究，对两组前瞻性记录的CAP患者进行了配对病例对照研究，所有患者均进行了SPUAT和血液培养。 CAP2例和CAP1对照者的年龄，年龄，性别和肺炎严重程度指数（PSI）得分是否在±10分之内，均相匹配。通过条件对数回归估计SPUAT阳性的几率（OR）。多元模型评估了各个变量的贡献。结果共招募498例患者。 CAP1期间为307，CAP2期间为191。比较这两个时期，我们观察到年龄，PSI得分以及先前用肺炎球菌疫苗和SPUAT阳性免疫的吸烟者，门诊患者的百分比，差异。另一方面，死亡率，疗养院入院率，肺炎球菌菌血症和入院率没有差异。匹配后，在CAP1的34名患者（23.4％）和CAP2的12名患者（8.3％）观察到因SP引起的SP引起的肺炎（p <？0.001），并且接受了6/145 CAP1 vs 33/145 CAP2的患者入院前进行肺炎球菌免疫（p <？0.001）。多元分析证实，独立于不属于PSI 5级，未接受肺炎球菌疫苗且未在肺炎发作中幸存下来，有两个因素增加了SPUAT阳性的可能性：在CAP1期间发生肺炎（OR α＝ 1.23）并具有肺炎球菌菌血症（OR ＝ 2.66）。结论与2001-2002年相比，我们观察到2015-2016年SP作为病原体的作用降低，以及入院前接受肺炎球菌免疫的患者数量增加。此外，由于成人肺炎的早期牛群免疫，2012年开始使用缀合的13价疫苗进行儿童免疫，可能是导致这些变化的另一个因素。

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